ABC | Volume 111, Nº4, Octuber 2018

Original Article de Souza e Silva et al Percutaneous coronary intervention in the State of Rio de Janeiro Arq Bras Cardiol. 2018; 111(4):553-561 Figure 1 – Kaplan-Meier survival estimates of patients submitted to one single percutaneous coronary intervention paid by SUS between 1999 and 2010 according to sex and age group in a one-year follow-up. 100 95 90 85 80 75 0 30 days 180 days 1 year Patients at risk Men 20-49 years old Men 50-69 years old Men ≥ 70 years old Women 20-49 years old Women 50-69 years old Women ≥ 70 years old 1987 7819 2435 917 4224 1881 (35) (21) 1931 7515 2222 879 4061 1715 1913 7390 2160 872 4002 1687 (122) (99) (21) (18) (62) (59) (28) (7) (125) (66) (76) (182) (114) (17) (97) (90) 1952 7637 2321 900 4127 1791 Analysis time Survival probability (%) Men 20–49 years old Women 20–49 years old Women 50–69 years old Men 50–69 years old Men ≥ 70 years old Women ≥ 70 years old Additionally, this study has some major strengths. First, it addressed a large number of patients (19,263) accompanied for more than 15 years, thus enabling the observation of important outcomes of interest in the future. Second, although only data from PCI paid by SUS were analyzed and, therefore, they could not mirror those observed with PCI paid exclusively with private resources, in the state of RJ the PCI paid by SUS accounts for the majority of the PCI procedures performed. Only about 25,3% and 33,5% of the population of the state of RJ in 2000 and 2010, respectively, had private health insurance, 18 so at least 7 out of 10 of the PCI procedures performed in the state of RJ between 1999 and 2010 were certainly paid by SUS . Third, the data analyzed were from the third most populous Brazilian state and from 23 hospitals in the state of RJ, enabling the assessment of a broad range of patients and a high number of hospitals, which represent patients treated in a regular medical practice. As to sex, former studies have examined the differences in survival or mortality rates between sex after a PCI. Although most agree that women present a higher prevalence of clinical risk factors and comorbidities when submitted to a PCI, 19 there is conflicting evidence as to whether being a woman faces an independent risk of survival or mortality after a PCI. Data collected from German hospitals on PCI with or without stent placement in stable and acute coronary syndromes show that, after adjusting for age, women had higher in‑hospital mortality rates than men only when the PCI was performed in the setting of ST-elevation myocardial infarction. 20 In the CLARIFY study, 21 similar rates of death for all causes after a one-year follow-up were observed for men and women with stable coronary artery disease submitted to PCI, after adjustment for baseline characteristics. On the other hand, data from the United Kingdom and Sweden 22 showed that, when adjusting for age, being a woman was an independent predictor for all‑cause mortality at 30 days and at one year after PCI performed for stable or acute coronary syndromes. In this study, even when clinical differences at baseline were not adjusted, women aged ≥50 years old tended to have lower survival rates than men the same age group in a 180-day follow-up, and in the youngest age group, women tended to have a lower survival probability even after over a 1-year follow-up. As to long-term survival rates, most of the studies have shorter follow-up periods compared to those in this study. Berger et al. 23 followed 4,284 patients in New York City for 3 years on average. Although men and women had the same in-hospital mortality rates, being a woman was independently associated with a reduction in hazards of long-term mortality. Similarly, the BARI study 24 showed that when adjusting for baseline risk status, women had higher survival rates in a 5-year follow-up when treated with PCI for multivessel coronary artery disease. In the present study women also tended to have higher long-term survival rates, even though for the youngest age group this tendency only occurred after a 10-year follow-up. 556